Announcements for Applicants
The Peer Support Programs in Diabetes report is now available online at
http://www.who.int/diabetes/publications/en/. This report is a summary from the World Health Organization Consultation held on November 5-7th in Geneva, Switzerland.”
Comments on Brief Proposals Submitted July 1
We have reviewed all of the Brief Proposals that were submitted July 1
for Peers for Progress Of valuation Grants. In doing so, we have
generated the following comments regarding the brief proposals and
important considerations for the full proposals that are due September
1.
General Comments
Proposal should describe the planned intervention, not just how it will
be developed such as with input from community groups. Of course, a
particular intervention may evolve and change over the course of a
project, but the application should include the applicants best
estimates of what their intervention will entail.
Length guidelines will be followed. Applications that exceed the specified guidelines will be returned.
Ongoing Support
In developing Peers for Progress, an important consideration is that
diabetes extends over many years -- for the rest of your life.
Consequently, those with diabetes need ongoing encouragement and
support in managing their disease. Thus, in the sense that Peers for Progress intends, peer support is /not/ a time limited intervention such as individual or group diabetes self management education that may last
for a fixed number of sessions. Rather, peer support needs to address the need for /ongoing / support among those with diabetes.
Key Components of Peer Support
Although proposed interventions should be of the applicants own design
and reflect the settings and populations with which they work,
interventions should reflect the three key components that capture the
essence of peer support described in the Call for Proposals (p. 2)
- Assistance in daily management and living with diabetes
- Social and emotional support
- Linkage to clinical care
It is expected that these three broad components or features of peer
support still leave substantial latitude for design of specific
interventions that reflect the thinking of applicants.
Evaluation
Please keep in mind that grants funded through Peers for Progress will
need to include evaluation of effectiveness or efficacy of peer
support. It will be important that evaluation include controls for variables
that may account for apparent benefits of peer support. Randomized designs are, of course, a sound approach to such control. However, because peer
support programs are often embedded in and take strength from complex
organizational, social or community contexts, randomized designs may
not always be practical or most appropriate. Alternative designs may be
proposed. These include but are not limited to such designs as:
- replication across several sites or settings
- wait-list or delayed treatment controls
- comprehensive statistical modeling of intervention and control
- variables with sufficient power to support strong conclusions about
program benefits carefully planned and executed program evaluation
models
In all cases, approaches to design and evaluation should be carefully
justified with reference to the specific objectives of the project, the
setting, the resources to support evaluation activities, etc.
Evaluation of Program Reach
It has been estimated that 60% - 70% of patients with diabetes have not
received self-management interventions (Austin in /Endocrinology
Practice/. 2006 12(Suppl 1):138-141). Peer support may contribute to
alleviating this omission in diabetes care. To evaluate the success of
peer support in reducing this problem, it is important that evaluation
grants include characterization of the reach of their programs to
intended audiences. This should include (a) specification of the
population for whom the peer support program is intended, (b) some
quantitative estimate of the size of that population, (c) estimate of
the extent of reach through quantification of the extent to which that
population is engaged in the peer support program, and (d) estimate of
the extent to which those reached are representative of the population
for whom the program is intended.
Breadth of Focus and Focus on Specific Issues or Problems
Applicants should be clear that the goal of the Evaluation Grants is to
generate evidence regarding the contributions to diabetes management of
peer support interventions. Peers for Progress will then use this
evidence to help in promoting peer support around the world. Given this
broad context for the Evaluation Grants, applicants should understand
that the focus of their proposed research needs to be on peer support.
A broader focus on diabetes self-management in general would not provide
evidence regarding peer support. On the other hand, a more narrow focus
on some unusual aspect of peer support would also fail to provide
evidence on the value of peer support in diabetes management. Instead,
applications should focus on peer support interventions that would have
some generality and applicability to large numbers of those with
diabetes.
Some brief proposals described peer implementation of fairly specific
interventions. Applicants should think carefully about whether they are
proposing a robust approach to peer support or, of less interest to
this grant program, a relatively unique intervention approach that will
merely be implemented by peers.
There are several Frequently Asked Questions on the website that
address the specificity versus breadth of peer support interventions.
These include issues regarding focus on diabetes prevention versus
diabetes management, children and adolescents versus adults, or
diabetes versus other diseases. These frequently asked questions and their answers are reprinted below:
Question: Is Peers for Progress only geared toward diabetes or does it include other illness groups?
Answer: As indicated in answers to other questions, the overall
purpose of Peers for Progress and of these Evaluation Grants is to
promote peer support for diabetes. Thus, grants funded through this
mechanism will need to include those with diabetes and to evaluate
intervention approaches that are broadly pertinent to diabetes.
However, interventions need not be limited to those with diabetes. For example, in some cases, a case might be made for inclusion of individuals who do not have diabetes on the basis of enhancing the support for or sustainability of an intervention.
Question: Are proposals addressing children and youth appropriate for Evaluation Grants?
Answer: Because the needs and circumstances of children with diabetes
are so different than those of adolescents and adults, procedures and
practices for promoting peer support for children would need to be
substantially different than those for organizing and providing peer
support for adolescents and adults. Thus, initially, PfP will not be
focusing on peer support for children with diabetes. Since Evaluation
Grants are intended to guide broader efforts to promote peer support,
it makes sense also to focus these grants on adults and adolescents.
Accordingly, in this round of funding of Evaluations Grants,
applications focusing on children will generally not be competitive.
Applications focusing on adolescents and adults should be developed
with consideration of the generality of their procedures and findings to
others with diabetes.
Subsequent phases of PfP may extend to include peer support for
children with diabetes. This surely would be a worthy area of activity. However, in order to enhance the impact of current funding, the focus of PfP and the research it supports at this time will be on peer support among adolescents and adults for whom similar procedures and approaches to Program Development are possible..
Question: What about support groups?
Answer: Very likely, in different settings, peer support will be
provided through blends of group and individual interventions. It will
be important that research supported by PfP address both of these modes
as well as other modes of support such as by telephone, electronic
media, or worldwide web.
Applications emphasizing group approaches should be developed with
attention to the generality of their procedures and findings.
Applications focused on unique or distinctive group-based approaches
that could not be implemented through individual support or other modes
of support would be somewhat limited thereby in their pertinence to
broad efforts to promote peer support and, thus, would need to be
especially well justified.
Question: What about special needs or populations among those with
diabetes, such preconception counseling or those with specific problems
associated with diabetes such as blindness, amputations, or
depression?
Answer: The objective of Peers for Progress is to promote peer support
for the general population of those with diabetes. Interventions
tailored to the needs of just a particular group would tend to focus on
intervention components not especially pertinent to the needs of the
broader population of those with diabetes. As such, they would not be
especially appropriate for these grants. However, interventions that
(a) are broadly appropriate to the needs of those with diabetes and (b) pay particular attention to common problems such as depression or vision
problems would be appropriate.
